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Longshore Form Center -

Type & Print Forms - programmed for direct type and print functionality.

Each form may be downloaded in Adobe Acrobat format. Download the form by clicking on the form number below.
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ls-202.pdf Employers First Report of Injury or Occupational Illness
ls-1.pdf Request for Examination and/or Treatment
ls-18.pdf Pre-Hearing Statement
ls-33.pdf Approval of Compromise of Third Person Cause of Action
ls-200.pdf Report of Earnings
ls-201.pdf Notice of Employee's Injury or Death
ls-203.pdf Employee's Claim for Compensation
ls-204.pdf Attending Physician's Supplementary Report
ls-206.pdf Payment of Compensation without Award
ls-207.pdf Notice of Controversion of Right to Compensation
ls-208.pdf Notice of Final Payment or Suspension of Compensation Payments
ls-210.pdf Employer's Supplementary Report of Accident or Occupational Illness
ls-262.pdf Claim for Death Benefits
ls-265.pdf Certification of Funeral Expenses
ls-266.pdf Application for Continuation of Death Benefit for Student
ls-267.pdf Claimant's Statement
ls-271.pdf Application for Self-Insurance
ls-272.pdf Application to Write Longshore Insurance
ls-274.pdf Report of Injury Experience of Insurance Carrier or Self-Insured Employer
ls-275ic.pdf Agreement and Undertaking (Insurance Carrier)
ls-275si.pdf Agreement and Undertaking (Self-Insured Employer)
ls-276.pdf Application for Security Deposit Determination
ls-426.pdf Request for Earnings Information
ls-513.pdf Report of Payments
ls-570.pdf Carrier's Report of Issuance of Policy
ls-801.pdf Waiver of Service by Registered or Certified Mail for Employers and/or Insurance Carriers
ls-802.pdf Waiver of Service by Registered or Certified Mail for Claimants and Authorized Representatives
owcp-5a.pdf Work Capacity Evaluation Psychiatric/Psychological Conditions
owcp-5b.pdf Work Capacity Evaluation Cardiovascular/Pulmonary Conditions
owcp-5c.pdf Work Capacity Evaluation for Musculoskeletal Conditions
owcp-16.pdf Rehabilitation Plan and Award
owcp-17.pdf Rehabilitation Maintenance Certificate
owcp-44.pdf Rehabilitation Action Report
ls-241-242.pdf Notice to Employees (Longshore) - Not currently available online. To inquire about this form please contact the Longshore National Office. (202) 693-0038
DBANoticetoEmployees.pdf Notice to Employees (Defense Base Act)